Re-engineering regional poison control center services.

In summary, I propose a model of poison control service delivery to replace poison control centers. A handful of financially self-sustaining poison consult centers would remain. All other services would be provided by health plans to their members, including those covered under State-funded managed care. The need for continued fundraising efforts would be eliminated. Rather than devoting large sums of money to consolidate the State's 6 centers into 1 large center, I encourage Blue Cross of California to fund the protocol development process that will drive a true restructuring effort for poison control services. In our hearts, if our goal is to ensure continued service provision, then let's take the initiative to re-engineer the way we do business. The risks of doing nothing more than seek continued funding for the existing service delivery model should be painfully obvious by now. If your individual goals include survival for your center, then there's great news. The demand for call centers providing a wide range of advice services is approaching a critical level. Most health and hospital systems are moving to a managed care environment. Health care delivery is quickly moving out of the hospital to ambulatory services. Telemedicine is here--and growing very quickly. Distance learning technology is knocking at the door. There is plenty to do. With sound strategic development, your center will survive--it just won't look or feel the same as its does today. Survival the way it used to be ...uh, except for the computers and stuff.

Cerebral resuscitation after cardiac arrest using hetastarch hemodilution, hyperbaric oxygenation and magnesium ion.

This study was done to investigate the effects of hemodilution, hyperbaric oxygenation, and magnesium sulfate on cerebral resuscitation. Sixteen mongrel dogs were anesthetized, and monitored via pulmonary artery catheter, arterial catheter and electrocardiogram. A left lateral thoracotomy was done. Ventricular fibrillation was obtained by application of a 6-volt AC current. Mechanical ventilation was stopped. Total arrest time was 12 min. All dogs were cardiac resuscitated within 6 min using internal massage, ventilation, bicarbonate, epinephrine and internal defibrillation. The animals were then randomized into three groups. Group I represented controls, and were not treated. Group II dogs received normvolemic hemodilution using hetastarch (Hespan) containing magnesium sulfate (2000 mg/l), resulting in a hematocrit of 20%-30%. Group III dogs received the above hemodilution plus compression in a hyperbaric oxygen chamber to 2 atmospheres absolute. Critical care management and hourly neurologic scoring was performed for 7 days by blinded observers. All dogs at the time of death underwent autopsies for gross study. Data analysis revealed no statistical difference among the three groups with respect to survival time, cardiac function or neurologic scoring.

Use of a line card sequencer for triage of poison center calls.

In 1984 the Poison Center installed a Dacon ACS-46 Automatic Call Sequencer. This device is connected to all incoming poison information lines (with the exception of a specially designated 911 line) and acts as an interface between callers and Poison Information Specialists during periods of heavy call loads. While the use of a call sequencer could never be termed ideal, such use offers a number of specific benefits in situations that are frequently encountered in Poison Center work. These benefits include: significant reduction in staff stress, caller assurance that a correct number has been reached, efficient triage of incoming calls, and accumulation of accurate incoming call data. Data input parameters of this system include: total calls offered, dropped calls, calls over alarm time, average time for completed calls, average time for dropped calls, and completed and dropped hold time data bins.